Our ability to keep people alive is now out-pacing our ability to keep people healthy. This is driving an increase in the number of people who need human assistance on a daily basis. In other words, it has driven an increase in caregiving.

By most accounts, caregiving can be one of the most overwhelming responsibilities of modern life. It is a relentless responsibility that is physically taxing and emotionally draining. While the range and availability of support services in most communities is growing, caregiving remains one of the most difficult challenges many of us will ever face.

I want to highlight some good advice for caregivers that was published recently at Caring.com. In a short summary of 10 tips, sorted into "5 Do's and 5 Don'ts", this easily absorbed article might have just the nugget of wisdom that some desperate caregiver out there needs to know.

I have summarized the 10 items here, but I strongly encourage you to click through and read the brief description of each in the full article:

Keep expectations real

Treat yourself as well as you treat the person you care for

Remember that knowledge is powerful

Prepare to have all of your relationships tested

Cherish the positive moments

Don't go it alone

Don't undersell what you do

Don't become isolated

Don't be ashamed of the emotions you feel

Don't go it alone (intentionally reiterated)

This article focuses on those who care for an Alzheimer's patient but the advice seems consistent with other good suggestions I have read for caregiving in general. I hope it helps -- please share it with anyone you know who might benefit from these tips.----------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

The reports on diagnosing Alzheimer's disease are maddeningly conflicting.

Research in academic journals makes it clear that a primary care physician can achieve a high level of diagnostic accuracy by following published guidelines. However, journalists report every day that Alzheimer's disease can only be definitively diagnosed with an autopsy. So which is it?

It turns out that both statements are correct.

Definitive vs. Clinically Acceptable
It is technically true that an autopsy is required for a "definitive diagnosis". However, in the world of practiced medicine, we rarely operate with definitive diagnoses for any disease or condition. Instead, we rely on "clinically acceptable" diagnoses that are accurate about 85%-95% of the time. The emphasis on "definitive", or 100% accuracy, is actually quite misleading since it establishes an unrealistic standard that is rarely met in the real world of medical practice.

As for the academic perspective, a clinically acceptable level of accuracy is indeed achievable by following published guidelines. These guidelines involve a complete medical history including a review of medicines, neuro-psychological assessment, blood tests, and an MRI or CT image of the brain. In some cases, a PET scan of the brain might also be required.

Diagnostic Guidelines
To paraphrase the guidelines: if a patient shows impaired short-term memory as well as impaired cued recall, is not taking any medications known to disturb memory, is not abusing alcohol or other drugs, is not depressed or suffering from anxiety, does not have any apparent or detectable infections, has no uncontrolled diabetes or hypertension, has a properly functioning thyroid and no particular vitamin deficiencies, has not suffered a recent head trauma, and has no evidence of strokes or tumors in the brain, then the physician can be quite confident that the patient has Alzheimer's disease.

Essentially, the hallmark forms of memory impairment need to be objectively confirmed by cognitive assessment, and other known causes of such impairment ruled out. A family history of Alzheimer's disease, or a genetic test showing a particular predisposition, would add confidence to such a diagnosis.

Why the Different Perceptions?
The reason for the stark difference in the academic perception of diagnostic accuracy and the journalistic perception of diagnostic accuracy is "lag". In this case, lag refers to the well documented time-gap between medical advance and implementation of medical advance. In other words, medical research leaps forward much faster than physicians can learn about and implement new findings and guidelines. Right now, there is a significant gap between best practices in the field of memory loss and the actual practices that physicians are using in their clinics.

Half of Alzheimer's Cases Misdiagnosed
Recent articles from CNN and WebMD have reported that about half of Alzheimer's cases may be misdiagnosed in clinics. Oddly, this probably indicates progress from recent years when memory problems went largely undiagnosed and ignored, to current times when many memory problems are being improperly attributed to Alzheimer's disease. Progressing from "doing nothing" to "doing the right thing half the time" is actually a favorable development.

With time, our over-worked physicians will gain a better command of emerging guidelines. This will improve their collective ability to recognize problems and to accurately determine their cause before prescribing treatment.

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Smoking is clearly bad for your vascular health. This has been well studied and consistently proven through decades of solid research. Since one key function of the vascular system is to deliver oxygen rich blood to the the brain, it stands to reason that a compromised vascular system could negatively affect the brain.

Based on data from the Rotterdam Study published in Neurology, the hypothesis that smoking's impact on the vascular system is ultimately bad for the brain, is likely to be true.

Researchers analyzed data from 6,868 subjects aged 55 and older for an average of 7 years, all of whom were dementia free at the start of the study. By comparing smoking habits, including number of packs per day and number of years smoked, to the eventual incidence of Alzheimer's disease and other causes of dementia, clear conclusions were drawn. Those subjects who smoked in midlife were approximately 50% more likely to be diagnosed with Alzheimer's or to become demented from other causes later in life.

In a more recent study, researchers looked at similar data from the Kaiser Permanente Medical Care Program of Northern California. In this analysis, researchers studied midlife smoking habits and their correlation to Alzheimer's and/or vascular dementia in later life, across 21,123 subjects over a 23 year period. They found that heavy smokers (2 packs/day) had about a 200% increase in risk for Alzheimer's and/or vascular dementia and that light smokers (half a pack/day) had about a 40% increase in risk.

The consistency of these findings should be noted, especially given the large sample and long period of the second study. It is safe to add "preserving the health of your brain" to the already long list of reasons why you should not smoke.

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For many years, we have heard that bilingualism creates confusion in the brain, especially in children. New research suggests this is not true.

In fact, two separate news items drawn from the same research have indicated possible benefits that accrue from bilingualism. The research, presented at the annual meeting of the American Association for the Advancement of Science, suggested a benefit to particular cognitive abilities as well as a possible benefit in delaying cognitive decline due to disease.

First, Penn State researcher Judith Kroll showed that speaking more than one language may benefit certain cognitive functions like organizing and prioritizing.

From a theoretical perspective, Dr. Kroll's claimed benefit makes sense. Bilingual speakers, who have demonstrated the ability to have both languages readily at their command, must constantly monitor an internal competition over word choice and grammatical structure, while simultaneously composing their spoken message. It stands to reason that they would have highly developed skills in the realms of organization and prioritization.

Second, York University researcher Ellen Bialystok, showed that using a second language throughout life, or perhaps even learning one late in life, might delay cognitive decline due to Alzheimer's disease.

Dr. Bialystok compared 450 Alzheimer's patients, all of whom had the same level of impairment at the time of their diagnosis. Half of the research subjects were bi-lingual and half were not. When she analyzed the ages of the subjects, she found that the bilingual group was 4 to 5 years older, on average, than the monolingual group. This suggests that the ability to speak a second language may have delayed the cognitive decline in the bilingual group.

Each day the evidence mounts. Using your brain and staying intellectually engaged seems to play an important role in maintaining a high level of cognitive health. Put down that remote and pick up a book.

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As we write here often, every apparent lapse in memory is not a sign of an underlying medical condition. Furthermore, even those lapses with an underlying medical cause, are often completely within our control.

A great article was posted today in the Huffington post describing how many, common, over the counter drugs, as well as many prescription drugs can cause memory loss. It's a well written article with a comprehensive list of drugs, sorted by class, that have been known to cause such problems.

If you use any of these drugs and sense a decline in your memory, you might consider speaking with your doctor about other alternatives.

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Is there a relationship between hearing loss and dementia? If so, what is it? There is a lot of press right now on this topic; the interest is driven by a publication in this month's issue of Archives of Neurology.

In the study behind the publication, researchers followed 639 men and women between the ages of 36 and 90, none of whom were demented at the start of the investigation. By monitoring the subjects' cognition as well as their hearing, researchers discerned a positive correlation between hearing loss and dementia.

Several theories were put forth to explain this result. However, I think the most obvious explanation of the potential relationship was not discussed in the paper.

Among the suggested explanations was the notion that hearing loss is merely a sign that someone is not aging very successfully from a biological perspective. Therefore, it would stand to reason that the health of that person's brain is also declining with age. That is possibly true but not very useful in terms of explanatory power.

A second thought was that hearing loss might be the result of nerve damage affecting the neurological processing of auditory signals. That seems plausible but also very speculative.

Finally, some suggested that hearing loss can lead to social withdrawal, and that low levels of social engagement have been shown to increase risk for Alzheimer's disease. That's logical. But those relationships are quite weak, and the evidence supporting them is scant.

I think there is a more obvious aspect of this study that must be considered. The researchers looked primarily at the relationship between hearing loss and dementia. As we know, dementia is not a disease but a classification of cognitive function. Specifically, dementia is defined as a state of cognitive impairment severe enough to interfere with daily activities.

The obvious confound here is that hearing loss by itself, even with a healthy brain, can also greatly interfere with daily activities. After all, it is hard to remember things that you never heard correctly to begin with. It is also difficult to focus on a complex task when your brain is fully engaged in trying to decipher and make sense of the garbled sounds you perceive with faulty hearing. To an unknowing observer, a research subject with hearing loss, who focused on the task of hearing, might look like he has cognitive problems when, he is actually just dividing his attention in a non-obvious way.

Perhaps some observed difficulties among the research subjects were caused by hearing loss and then misclassified by the researchers as cognitive problems. This would lead to the false appearance of a relationship between hearing loss and dementia in cases where the researchers were really only observing hearing loss.

Obviously, my thoughts on this matter are no more well supported than the other explanations I noted above. But when a story explodes in the press as this one has, I think it is useful to consider it carefully, and to draw conclusions only after a prudent and diligent review of the facts.

Eating berries and other foods that contain the pigment flavone (known as flavonoids), has been shown to have many health benefits. Now, according to research set for presentation at the annual meeting of the American Academy of Neurology in April, eating such foods may also lower one's risk of Parkinson's disease.

In an extensive study of more than 100,000 subjects followed for more than 20 years, researchers tracked dietary habits of the research participants and carefully monitored intake of flavonoids. In the final analysis, male participants with the highest intake of flavonoids, had a 40% lower incidence of Parkinson's disease than those with the lowest intake of flavonoids.

Importantly, this apparent risk reducing effect did not translate to women. However, a subclass of flavonids (anthocyanins), showed risk reducing benefits for both men and women.

This was a major study involving a huge sample and a long period of follow up. Nonetheless, as per the scientific process, final conclusions will be withheld until additional studies duplicate the findings, and a solid explanation is put forth as to why flavonoids accrue such benefits.

In any event, this is an impressive study with an optimistic result. It is especially welcome news given that there are no known downsides to adopting a flovonoid-rich diet of fruits and berries.

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Is this a crisis? Two news items with similar themes, springing from disparate sides of the research funding equation, have been in the press this week.

First, I noted that the CEO of Eli Lilly, making a keynote address at The Economist's 2011 Pharma Summit, shared his strong view that current regulatory environment cannot sustain ongoing investment toward much needed innovation. He made these comments specifically in regard to the neuroscience field, where the diseases are complex, developing new treatments costly, and economic returns uncertain.

His unspoken message was that major R&D investments from big pharma may not be sustained, even as the aging of the population increases the need for better treatments of Alzheimer's disease and other age-related conditions.

Secondly, Reuters has reported the view from academia that prospects for future investment in the neuroscience field will be bleak without new incentives to encourage such spending. An excellent article summarizing the situation suggested patent law and the regulatory pathway as two areas where governments can cooperate with industry, to improve prospects for a return on new investment.

This is something to think about. For sure, the need for better AD treatments is dire and will only intensify in the coming years and decades. At the same time, profit driven pharmaceutical companies must strategically allocate their investment funds into areas that optimize a return.

Remember, there is no moral obligation for any corporation to perform "in the interest of humanity". To the contrary, corporations have a legal obligation to perform "in the interest of their shareholders", which is to optimize economic returns. Sometimes, helping humanity translates into profits, but the correlation is far from perfect.

Going forward, the best and most immediate solutions will likely come from a well orchestrated effort between private economic interests, academic resources, and prudent public policy that reduces barriers and provides the right motivation to invest.

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The complexity of the brain is boundless. Each day it seems, scientists uncover new findings that either raise new questions or broaden our perspective on how disease and cognition are inter-related.

According to a study from the University of Alabama, research subjects aged 45 and older, who scored poorly compared to their peers on a memory test, were about 3.5 times more likely to have a stroke in the next 5 years.

While the average age of the study participants was 67 years, the correlation between memory loss and a later stroke was especially strong at younger ages. For example, at age 50, those who scored in the bottom 20% on the memory test were almost 10 times more likely to have a stroke in the next 5 years, compared to those who scored in the top 20%.

It is difficult to draw any concrete conclusions from this study about how, or why, poor memory performance might be a marker of pathology that increases risk for stroke. However, each piece of evidence shapes the entire puzzle that must eventually be assembled.

Knowing this relationship between memory performance and stroke risk will guide further thinking and move us toward a deeper understanding of brain health and function.

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Yes, there are illnesses and medical conditions that can cause declines in brain health. But no, none of them are inevitable. So what are the realistic chances of losing your memory as you age?

Many studies have looked at the prevalence of various problems that cause memory loss and other cognitive problems. New figures from the Agency of Health Care Research and Quality, part of the U.S. Department of Health and Human Services, show the prevalence of "identified" problems in the health care system, as reported through their home survey.

According to this survey, the reported prevalence of cognitive disorders by age group are:

Age 65-74: 1.1%

Age 75-84: 6.0%

Age 85+: 18.4%

Despite the fact that these figures include all cognitive disorders resulting in delirium, dementia, and/or memory loss, the reported prevalence is much lower than what we frequently see reported for Alzheimer's disease alone. Here are a couple of considerations about why the figures may not match.

First, these data are based on "self-reporting" through a household survey. Self reporting, as opposed to direct observation, is known to be somewhat inaccurate. This is especially true among groups of people known to have memory or other cogntiive impairments.

Second, these data do not represent actual prevalence of problems. Instead, they represent reported results from seniors on whether or not they have been clinically diagnosed with any particular problem. Given the well documented fact that many (probably most) early stage problems go undetected for many years in primary care settings, this survey probably included people with cognitive problems who have not been diagnosed, and subsequently did not report them.

Despite the need to reconcile these data with other published findings, it is good to get a read on the prevalence of diagnosed/reported cognitive problems by age group, as a general guide toward future expectations.

Overall, the chances of facing some medical problem that will impair memory or cognition, are probably a little higher than noted in the figures above. However, many of those problems are completely curable and all can be treated with some effectiveness. Additionally, our ability to manage the most feared condition in this group, Alzheimer's disease, is improving each day.

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It is clear that beta-amyloid plays some role in Alzheimer's disease. Most experts in the field believe that plaques of this protein are the key culprits, causing the death of brain cells and declining cognitive capacity. But to be sure, there is still a lot we don't understand about how Alzheimer's disease progresses.

As testimony to this lack of clarity, data presented at the 5th annual Human Amyloid Imaging meeting, held last month in Miami, raised as many questions as were answered. An excellent summary of the presentations is available at the Alzheimer Research Forum.

Of particular note, certain studies showed that amyloid accumulates in the brain throughout the disease course with some maximal load manifesting in the latest stages of dementia. Other studies showed that plaque formation began several years before the first symptoms of the disease and leveled off around the time of first symptoms. One of the largest data sets, from Avid Radiopharmaceuticals, suggested that variability of amyloid levels across individuals was so great, that group averages would continue to obscure the picture until more data is collected.

At the end of the day, amyloid will remain a target of intense scientific scrutiny until a better understanding of Alzheimer's pathology, and the role of amyloid, are both more completely understood.

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There is much needless confusion about certain aspects of the Alzheimer's field. In fact, this blog exists almost solely to help reduce that confusion.

Many bloggers, and some sloppy journalists, compound the problem with their inaccurate daily descriptions and ambiguous word choices. Here are 5 things I wish they would all get straight:

1. Alzheimer's is but one disease, albeit the most common, of many that can lead to dementia.

Parkinsons's disease, stroke, head injuries, and a host of other medical conditions can also lead to dementia. Alzheimer's is a progressive disease that seems to begin with an accumulation of amyloid protein in the brain, followed by subtle symptoms of memory loss, and eventually, enough brain damage to render a person demented.

2. The term "Dementia" does not refer to a disease.

Dementia is a term that describes a fairly advanced state of cognitive decline, when diminished brain health is so severe that it interferes with a person's life. How a person has arrived at that state of diminished brain health is a separate and distinct matter.

Importantly, when you hear about "early dementia", you are hearing about the earliest stages of a condition that is already quite severe. A little memory loss is a problem that should be evaluated, but it is not "dementia" until it becomes so severe that it interferes with daily living.

3. Early detection of Alzheimer's is not the same as "predicting" Alzheimer's disease.

In the first case, we would identify the pathology of AD and provide optimal treatment, prior to the massive brain damage that eventually causes dementia. Predicting risk, on the other hand, is still a very uncertain science with complex pros and cons. (So complex, in fact, that many bio-ethicists are currently able to earn a living discussing them.)

4. Having "no cure" for Alzheimer's is not the same as "having no treatment".

Controlling symptoms and slowing disease progression are both beneficial outcomes short of a cure. Because we don't understand the disease well, it has been difficulty to identify drugs that significantly alter the disease course. However, much of the perceived inability to treat the disease is driven by the fact that we identify AD much too late, and intervene only after major brain damage has occurred.

The negative perception of treatment is also driven by a narrow focus on drug efficacy, as opposed to the combined effect of a more robust treatment approach involving diet, exercise, and management of contributing conditions.

5. Very few diseases can be diagnosed with 100% certainty, Alzheimer's is not particularly unique in this regard.

By following published guidelines for a diagnostic work-up, physicians can accurately diagnose AD more than 90% of the time. This is well within the range of acceptable clinical certainty. The repeated mantra in the press, that an autopsy is required to diagnose AD with 100% certainty, may be true but is also nearly meaningless.

With more careful reporting on these 5 aspects of Alzheimer's disease and dementia, we could eliminate much unnecessary confusion which could help us approach solutions with more clarity and success. Please share this post with your online networks to help spread the message.

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Transient ischemic attacks are common. They are known as TIA's or mini-strokes, and they produce temporary symptoms of numbness, tingling, and sometimes, weakness or difficulty speaking. They are caused by a temporary lack of blood flow to the brain and, as the term "transient" suggests, they have generally been considered to be temporary events, with no lasting effect.

According to a recent publication in Stroke, the journal of the American Heart Association, these events may not be as transient as previously believed. Researchers from the University of British Columbia performed transcranial magnetic stimulation (TMS) on subjects who had suffered a recent TIA and found interesting results. These subjects' brain cells were more difficult to stimulate, as is necessary in learning and recalling information, than the brain cells in subjects with healthy brains.

TIA's have long been considered a warning sign that more serious, future strokes could be more likely. But this new information suggests that they are more than a warning sign of future problems; they might be a part of a current problem with long-term effects on brain health.

For perspective, this was a small study involving only 13 subjects, and the results have not yet been reproduced in other peer-reviewed publications. It is merely the first step, and perhaps an important one, in the scientific process by which we discover and validate new knowledge.

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We have written many times that the world does not need a single, sweeping answer to the question about whether or not tests should be available to inform people about their future risk for Alzheimer's. It is a question with as many individual answers as there are individuals on the planet. Each person is entitled to make that decision for themselves so, of course the tests should be available. Anyone who doesn't wish to know their risk profile will opt not to learn it. Those who do wish to know, on the other hand, can do so.

However, the notion of individual rights to make their own decisions has not stopped a growing number of bio-ethicists from debating the topic on a daily basis. They seek, for some reason, one unified position to which all people should adhere; the single, optimal stance on this complex issue.

In fact, the complexity of the issue is driven by the variability of individual circumstances across a population. What is best for one person is not best for another. A fantastic overview of the debate was published yesterday at reason.com. If this is a topic of interest to you, I encourage you to click through and read it.

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While better education and higher awareness about Alzheimer's disease are key themes in this blog, we also emphasize the many other medical conditions that are also associated with memory loss. Among those conditions is Metabolic Syndrome.

As per a recent article posted on WebMD, Metabolic syndrome is a common condition characterized by a cluster of symptoms that can include high blood pressure, too much weight around the waist, elevated blood sugar levels, low levels of HDL “good” cholesterol, and high levels of tryglycerides, a type of unhealthy fat found in the blood.

According to a study published yesterday in Neurology, subjects with metabolic syndrome, are more prone to cognitive decline in their later years. While this group was previously known to have higher risk for heart disease, it is now more clear that they face an increased cognitive risk as well.

Given a large body of evidence showing that active management of blood pressure, blood sugar, cholesterol, and body fat can reduce the risk of heart disease, it is reasonable to speculate that such practices might also reduce the risk of cognitive decline. Certainly, it couldn't hurt.--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

This graphic depicts the federal commitment to Alzheimer's research compared to the commitment we make to other diseases. All are worthy causes and deserve strong funding support. However, the relatively small investment in Alzheimer's disease indicates how slow we have been to recognize the severity of the looming epidemic.

We recently posted that the National Alzheimer's Prevention Act was passed into law and we pointed out in that post that the law had no funding attached. Please follow this blog, and encourage your friends to do so as well, and we will keep you informed about how to lend your voice to support an increase in funding for Alzheimer's research.

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We have discussed similar evidence in many earlier posts, but when new studies garner lots of press, we like to weigh in and share our perspective. Especially on research that suggests new insights into how and why physical exercise benefits the brain.

In a new study published in the Proceedings of the National Academy of Sciences, walking was once again shown to improve brain health, this time as demonstrated by hippocampul volume. The hippocampus is a small region in the brain where short-term memory is processed. It is known to shrink as we age and it's relative size has been shown to correlate with memory capacity.

In this study, 120 sedentary adults between the ages of 55 and 80 were divided into two groups. One group began a regimen of regular walking while the other began a regimen of stretching and toning. After one year, the group that walked showed an average increase in hippocampul volume of about 2% whereas the other group, who did not participate in aerobic exercise, showed an average decrease in hippocampul volume of about 1.5%.

What is most notable in this study is that the walking regimen was fairly minimal. The expansion of the hippocampus and a measured improvement in spatial memory were obtained by walking for just 40 minutes per day, three days per week.

Given the potential benefits for such a minimal effort, it seems like we should all consider embracing the habit of a short, regular walk.

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